There are nearly 1.5 million older adults residing in nursing homes (NH) across the United States. Reducing avoidable hospitalizations among vulnerable NH residents has become a national priority. Estimates suggest more than $14 billion of Medicare funding is spent annually on hospitalizations for this vulnerable population. The most common causes of avoidable hospitalizations are conditions of septicemia, pneumonia, congestive heart failure, and urinary tract infections. Experts identify that NHs have limited capacity for early illness detection and/or prevention to avoid the need for hospitalization. As such, it is vital that NHs improve their capacity to identify and treat acute illness in their residents to avoid hospitalization. Evidence suggests that advanced practice registered nurses (APRNs) improve NH outcomes including reducing avoidable hospitalizations. Moreover, major health care cost savings have been measured when APRNs work in NHs. This improvement appears to be related to the APRNs expertise in clinical management of health conditions, early detection of illness, and problem-solving with NH staff to provide the needed care to manage clinical conditions within the NH. Despite evidence that APRNs improve resident outcomes, little evidence exists to describe how APRNs actually integrate their advanced practice role into NHs to influence care delivery. This article reports on a series of 3 focus groups held with APRNs who were embedded full-time in 16 Missouri NHs. The purpose of the focus groups was to describe the integration of APRNs into the NH setting including their perceived challenges and successes.
Vogelsmeier, A., Popejoy, L., Rantz, M., Flesner, M., Lueckenotte, A., & Alexander, G. (2015). Integrating advanced practice registered nurses into nursing homes: The Missouri Quality Initiative experience. Journal of Nursing Care Quality, 30(2), 93-98.View the PDF